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Is gun violence actually a public health issue?

Cheryl Crim, second from left, to right and daughter Haley Crim, 19, from Sandy Spring, Md., join a rally with legislators, gun violence survivors, families on the steps of the Capitol in Washington, Wednesday, July 6, 2016, calling on House Speaker Paul Ryan to allow votes on gun violence prevention legislation. (Manuel Balce Ceneta/AP)

For over two decades, there has been a virtual freeze on gun violence research in the United States. In 1996, Congress passed a bill preventing the use of federal funds for studies that advocate gun control, which was widely interpreted as preventing all research into firearm violence. Though U.S. President Barack Obama reversed the order in 2013, Congress continues to block dedicated funding. And this data deficit is posing a significant complication for those hoping to find a solution for America’s gun-death epidemic.

Dr. Michael Siegel, a professor of Community Health Sciences at Boston University, stresses that gun violence is a public health problem. But before preventative measures can be taken, he says, Americans need research. On Friday, Maclean’s talked to Siegel about how the lack of federal funding is harming firearms research in the United States, and what that means for public opinion.

Q: Why do you think of gun violence as a public health issue?

A: In public health we are concerned about the major causes of death. There are really two things that make something a public health issue. One is the burden of disease on the population and the second is the fact that we can do something to prevent it. So, if you look at smoking: Why is it a public health issue? Because, number one it’s killing 400,000 Americans every year and number two, there are interventions that we can do on a societal level to reduce smoking… The same should be true of firearms. They’re killing 30,000 people a year — about one-third of those are homicide and about two-thirds of those are suicides — but there are things we can do about it. It’s clearly a societal problem, there are clearly societal approaches to it.

Q: In order to treat gun violence as a public health issue, you note that Americans need to first accept there’s a problem, and that it’s preventable. That seems like a difficult task, as there’s a significant population that doesn’t appear to agree.

A: That’s the way the government has treated it. If you read how politicians react to these tragedies that keep happening, the usual response is, “our thoughts and prayers are with the victims,” rather than “I’m going to put an end to this, and I’m going to put an end to this tomorrow.” With a terrorist attack, our actions are typically very very different: “this will never happen again,” “not on our soil,” “we’ll do everything we can to prevent this.” But certainly the everyday violence that is killing many many people, and disproportionately African Americans, is [deemed] acceptable in society. It really is.

Q: Over time, public sentiment towards serious health concerns like HIV and smoking has shifted. Will that happen with gun violence?

A: That’s exactly what needs to happen. The social norms regarding gun violence have to change. The way we view guns as a society and their role in society has to change. Those are social changes that take time but I do believe they can happen. Thirty years ago, when I started getting involved in tobacco control … everybody would have said, ‘C’mon that’s impossible.’ But it happened. And I think the same is true of firearms violence.

Q: In the cases of HIV and smoking, public sentiment changed in large part due to significant research and data. How can America get to the ‘acceptance’ stage if there’s very little research?

A: Well you’re exactly right. We can’t. That’s the problem. When you cut off the research you basically cut off the ability to put the kind of information out there that is needed in order to facilitate social change. Social change with regard to smoking didn’t happen on its own. It didn’t occur because it was a natural progression, it happened because of a concerted effort on the part of public health practitioners, government, educational institutions, and community who basically committed themselves to tackling the tobacco epidemic.

Q: Is the problem one of not enough research, a need for better research, or improved communication of research that’s already out there?

A: Unfortunately, the stage we’re at with gun violence research is basically that we need more research. We’re not at the stage where the problem is we’re not communicating what we have, or we’re not doing the right research. The problem is just that there’s not enough research being funded. The budget for CDC research on gun violence is basically zero. It’s not an issue of the CDC doing the wrong research, or they’re not communicating, they’re just not doing anything.

Q: Aren’t there other centres that can do the research?

A: Even with other centres, the question is always, ‘Who is going to fund it?’ The federal government is basically not funding it. One of the things President Obama did was, by executive order he ended the long-term ban on federal funding for firearms research, which is great. But the problem is the government agencies and Congress still have to allocate the money, the funding, and right now my understanding is that there’s only about $2 million a year that’s being used for funding for firearms research. So even though the government technically is allowed to fund it, it’s obviously not a priority if we’re only spending a drop in the bucket on it.

Q: How little research is there really?

A: I can compare it to other fields. I’ve worked in the tobacco field and I’ve worked in the alcohol field and there are literally thousands and thousands of articles on tobacco. … In alcohol [the amount of research is] a little smaller than tobacco, but there’s still a fairly large literature. When I got into these fields, the first thing I did was to try to review all the literature. For smoking it has basically taken me twenty years to really become familiar with the literature, there’s so much of it. With alcohol it actually took significantly less time. Within about four years I was pretty well versed in the literature. With firearms, it took literally about a month. There just wasn’t that much. Within a month I basically had seen and read the bulk of what was out there. So it’s not even close. It’s not a coincidence. It’s a direct result of the lack of funding over the last two decades.

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Is gun violence actually a public health issue?

Treating gun violence as a public health issue is dishonest. It’s simply a way to medicalize a social phenomenon. Public opinion is already against crime. Suicide is no longer an offence and “doctor assisted suicide” supporters- including the SCOC and the GOC want to increase it’s frequency.

Most homicides in the US occur in the “inner city”. The cause isn’t a disease. The causes (and the studies have been innumerable) are the lack of stable families, terrible economic conditions and the hyper macho drug/ gang culture that is the result.

@Michael Shannon – you have no clue. I live in the U.S. – every morning, when I watch my local news, there are two or three new, overnight shootings announced. These are not “inner city” crimes (Phoenix does not really have an “inner city”), these are typically family dramas – argument, a disagreement and someone gets shot, or more often than not, a murder/suicide, even road rage. Living in the U.S., it’s astounding how commonplace gun violence is. When I lived in Montreal, you rarely heard about gun violence – local news was more about politics, fires or stabbings, and the rare case of a gun violence….nothing like the daily, almost common occurrence it is here. So before claiming “most homicides in the U.S. occur in the “inner city””, I suggest you actually do a little research. People die of gun violence in small towns just as they do in big cities in U.S.. 84% of whites are killed by other whites and 90% of blacks are killed by blacks.

@Michael Shannon. Violence is very much a public health issue whether it is guns or other. You are right however that gun violence culture is a social phenomena. So how do we treat maladaptive social phenomena? The phenomena you describe of a lower socioeconomic area is perpetuated by ACE’s Adverse Childhood Experiences. It can afflict any part of society and strata. It is a cycle stuck in negative/nurture environs. If we treat ACE’s as a public health issue, many of our social ills may be mitigated. https://www.cdc.gov/violenceprevention/acestudy/

The author of this article may not be aware that the NRA has very aggressively and successfully lobbied against the CDC’s desire to study gun violence as a health issue. And because of the financial support given congressmen and senators by the NRA (which, in turn, gets the majority of its money from gun manufacturers), this stance will continue.

There is an exceptionally good article in this month’s Vanity Fair entitled “Whose N.R.A. is it anyway?” What an eye-opener!

Good old Michael Siegel, the quintessential expert for hire. I guess tobacco isn’t as lucrative as it once was, so time to branch out into gun control.
I feel sorry for greedy people, it’s really a sickness.

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